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acquisition, mammography screening, and physicians’ preventive practices with
smokers) and, again, that each stage of change was predictably related to the
patterns of pros and cons for the participants.
In addition to underscoring the importance of motivation in the change
process (it is a primary mechanism by which a person advances to the next stage of
change), the TTM also provides a framework for the MI therapist to determine
which styles and techniques are most appropriate for the client at a particular stage.
For example, the decisional balance may be particularly useful in the contemplation
stage whereas affirmation work focusing on self-efficacy might become a priority
after a relapse. Furthermore, given that change can be difficult, that relapse does
happen, and that relapse can have a great impact on a client’s thoughts and feelings
about attempting to change a target behavior again, MI and its use of empathy and
its acceptance of ambivalence, is particularly well suited to helping clients
throughout the TTM’s stages of change.
Motivational Interviewing Outcome research
To date there are well over 50 studies on the outcome of MI interventions
and two meta-analyses on the topic have been published since 2001. Dunn,
DeRoo, and Rivara (2001) reviewed 29 randomized clinical trials of therapies
purported to use a MI approach. They found the greatest effect sizes in the studies
of MI with substance abuse and overall found that 60% of the studies “yielded at
least one significant behavior change effect size.” (Dunn et al., 2001). Although
Rollnick and Miller both raise the criticism that Dunn and colleagues had inclusion

Current evidence suggests that Motivational Interviewing (MI) can help to create behavior change in a variety of contexts, especially for those with alcohol use problems, but evidence is less clear on how and why MI seems to work. Using the Articulated Thoughts in Simulated Situations paradigm (ATSS), this study aimed to determine the mechanisms by which MI may modify the cognitions and behaviors of college-aged binge drinkers. Two mechanisms typical of an MI intervention were isolated, simulated, and analyzed: the presence of a warm/Rogerian therapist communication style and the use of a decisional balance exercise. By using a 2X2 design to compare these mechanisms to commonly used alternative therapeutic approaches, we sought to determine which mechanisms have the greatest impact on cognitions related to binge drinking and on intention to change, intention to drink, overall impressions of drinking, as well as actual changes in drinking behavior at a 30 day follow-up. As in a previous study, we found moderately strong evidence supporting the validity of the ATSS scenarios for our purposes. No significant effects were found on drinking behavior or any other variables at 30-day follow-up. However, as in the earlier study, the data show that, as compared to a more directive and confrontational communication style, the warm/Rogerian therapist style was associated with significantly fewer participant cognitions reflecting resistance to change during the ATSS scenario (a simulated therapy session) and with a temporary increase in readiness to change immediately after the scenario. We also found that, regardless of condition, higher levels of trait reactance increase the degree to which participants report that the therapist influenced them to think about not changing their drinking behavior.; This study provides evidence that the warm/Rogerian therapist style advocated by MI is animportant and active ingredient in psychotherapeutic process and, as such, should be a focus of clinical training and that attention to trait-like variables like reactance may help improve our understanding of MI and psychotherapy processes and outcomes in general.

20
acquisition, mammography screening, and physicians’ preventive practices with
smokers) and, again, that each stage of change was predictably related to the
patterns of pros and cons for the participants.
In addition to underscoring the importance of motivation in the change
process (it is a primary mechanism by which a person advances to the next stage of
change), the TTM also provides a framework for the MI therapist to determine
which styles and techniques are most appropriate for the client at a particular stage.
For example, the decisional balance may be particularly useful in the contemplation
stage whereas affirmation work focusing on self-efficacy might become a priority
after a relapse. Furthermore, given that change can be difficult, that relapse does
happen, and that relapse can have a great impact on a client’s thoughts and feelings
about attempting to change a target behavior again, MI and its use of empathy and
its acceptance of ambivalence, is particularly well suited to helping clients
throughout the TTM’s stages of change.
Motivational Interviewing Outcome research
To date there are well over 50 studies on the outcome of MI interventions
and two meta-analyses on the topic have been published since 2001. Dunn,
DeRoo, and Rivara (2001) reviewed 29 randomized clinical trials of therapies
purported to use a MI approach. They found the greatest effect sizes in the studies
of MI with substance abuse and overall found that 60% of the studies “yielded at
least one significant behavior change effect size.” (Dunn et al., 2001). Although
Rollnick and Miller both raise the criticism that Dunn and colleagues had inclusion